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2. Release Date*
   Release Date
4. Show Title*
6. First Name*
7. Last Name*
9. Phone Number*
11. Email Address*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Authorized People for Picking Up Art*

    Who may pick up/remove or dismantle entry on Artist behalf? Name/Phone

23. Entries
25. 1
26. Title of Piece*
27. Medium*
28. Price*
31. Date Out*
    Date Out
32. Initial Out*
34. 2
35. Title of Piece
36. Medium
37. Price
40. Date Out
    Date Out
41. Initial Out
43. 3
44. Title of Piece
45. Medium
46. Price
49. Date Out
    Date Out
50. Initial Out
56. Electronic Signature Agreement*

    I have submitted my work to be on loan at Brooksville Gallery 201 for exhibit.

    
    

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
58. Electronic Signature*
59. Date*
    Date
61. Gallery 201

    At The Brooksville City Hall

    201 Howell Avenue 

    Brooksville, Florida 34601 

    Phone (352) 540-3810

    Mission Statement: Brooksville Gallery 201 is sponsored by the City of Brooksville. It is planned and arranged by an Art Gallery Coordinator and volunteers. The Gallery is free and open to the public from 8 am to 5 pm Monday through Friday and is located downtown in the Brooksville City Hall on the first and second floors. The exhibit area is a public, not a private gallery. There are four (4) exhibits annually and include a reception where the public is invited to visit with the exhibiting artists.

    The Brooksville City Government, by establishing Gallery201, hopes to encourage the arts, and establish respect for artistic endeavors, and create a stimulating environment for those viewing artistic works. 

    
    

    Selling of Art: It is up to the purchaser, interested party and the artist to conduct business. It is the responsibility of the artist to contact the Art Gallery Coordinator that a work has been sold. The artist can then have the client wait until the end of the exhibit, or if it would affect the sale, the work may be taken out of the exhibit at any time and replaced with another work of the same size by the artist. Gallery201 collects a commission of 20% from each piece sold. These funds are utilized for the sole reason of supporting the logistical efforts, marketing, receptions, and the various activities associated with Gallery201. There is no entry fee for any exhibits.  

    Publicity: Gallery 201 may issue press releases or other public relations materials to publicize exhibits in various media outlets. The artist provides permission for the use of photographs of exhibited works on the City website www.cityofbrooksville.us, the City of Brooksville Government Facebook page, the Brooksville Gallery 201 Facebook page or other City owned social media sites. Unless otherwise specifically restricted, in writing by the artist, prior to the artist exhibiting works in the Gallery. By agreeing to show artistic works as an exhibitor in the Gallery, the artist grants his/her express permission to release his/her biographical information. This information may be provided to Gallery201, to local media outlets and to the public. The artist will give permission to Gallery201, to local media outlets and to the public.

    Insurance: Each piece of work submitted to the Brooksville Gallery 201 is insured for up to $300. If more coverage is needed, the artist will be responsible for securing the additional insurance.

    The artist is responsible for keeping track of dates of pick-up and drop off of artwork based on schedules, emails, and communication from the gallery. Artwork will be dropped-off and picked up during the posted times; any times outside of the posted times may be arranged by appointment only. Any artwork exceeding 1 month (30 days) of an exhibit’s pick-up period shall be considered abandoned and will become an asset of Gallery 201.

    Urgent Situation: Artwork will only be released with the artist’s written permission and the artist's notification to the Art Gallery Coordinator. Only the artist or Art Gallery Coordinator can release artwork.

    
    

    I have read and understand the policies as stated above

63. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
65. Electronic Signature*
66. Date*
    Date
68. First Name*
69. Last Name*
70. Date*
    Date
72. Address*
74. City*
75. State*
76. Zip Code*

78. Gallery201 Artist entrance and release form version 1.3                                                                                                                                                                                                February, 2023 

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80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit

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